Neurological assessment system and method

ABSTRACT

This document discusses, among other things, systems and methods configured to receive affect information from a patient in response to a provided affect inquiry and to receive real world activity information from the patient in response to a provided real world activity, and to provide patient neurofunction assessment information using the affect information and the real world activity information.

CLAIM OF PRIORITY

This application claims the benefit of priority under 35 U.S.C. §119(e) of U.S. Provisional Patent Application Ser. No. 61/771,443, titled “NEUROLOGICAL ASSESSMENT SYSTEM,” filed on Mar. 1, 2013 (Attorney Docket No. 4008.001PRV), which is incorporated by reference herein in its entirety.

BACKGROUND

It is estimated that one in three people will suffer some sort of brain disorder over their lifetime. A majority of brain disorders are mild, and even remain undiagnosed. However, brain disorders are still responsible for more death and disability than both cancer and cardiovascular disease combined.

Cognition is the mental process of knowing, and includes aspects such as awareness, perception, reasoning, and judgment. Various cognitive assessment tools have been used to assess cognitive function in patients with severe brain disorders to diagnose the type of injury, the area of injury, or to monitor patient progress. However, existing cognitive assessment tools fail to assess cognitive function of patients with mild to moderate impairments.

OVERVIEW

This document discusses, among other things, systems and methods configured to receive affect information from a patient in response to a provided affect inquiry and to receive real world activity information from the patient in response to a provided real world activity, and to provide patient neurofunction assessment information using the affect information and the real world activity information.

This overview is intended to provide an overview of subject matter of the present patent application. It is not intended to provide an exclusive or exhaustive explanation of the invention. The detailed description is included to provide further information about the present patent application.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings, which are not necessarily drawn to scale, like numerals may describe similar components in different views. Like numerals having different letter suffixes may represent different instances of similar components. The drawings illustrate generally, by way of example, but not by way of limitation, various embodiments discussed in the present document.

FIG. 1 illustrates generally an example computerized assessment system including a neurological assessment tool and an assessment module.

FIG. 2 illustrates generally an example computerized assessment method configured to assess patient neurofunction.

FIG. 3 illustrates generally example patient neurofunction assessment information.

FIG. 4 illustrates generally example neurofunction assessment information including patient strengths and challenges in real world function.

FIG. 5 illustrates generally an example computer system.

DETAILED DESCRIPTION

Brain disorders vary from concussions and traumatic brain injuries (TBI) to dementia, neurodegeneration, stroke, and mental illness, each type ranging in severity, from mild to moderate or severe. Many existing cognitive assessment tools focus on diagnosing severe impairment, but struggle with mild to moderate brain disorders. In contrast, the systems and methods disclosed herein are configured to identify strengths and challenges in patient neurofunction using real world activity information, in certain examples, especially applicable to patients with mild to moderate brain disorders.

The present inventors have recognized, among other things, computerized assessment systems and methods to comprehensively assess neurofunction of a patient using a neurological assessment tool, such as a web-enabled, portable, touch-screen tablet computer, smartphone, or one or more other computing devices configured to receive information from a patient or one or more other third parties separate from the patient using one or more input on the neurological assessment tool. Neurofunction can refer to, for example, a functional status of a patient as related to their neurological condition, whether healthy or dysfunctional, including their abilities (physical, cognitive, psychosocial), activity participation, or quality of life.

FIG. 1 illustrates generally an example computerized assessment system 100 including a neurological assessment tool 102 including a user interface 110 and an assessment module 112 configured to provide patient neurofunction assessment information. In an example, the neurological assessment tool 102 can include a tablet computer, a smartphone, or one or more other computing devices including a patient assessment module 114 configured to receive affect information from a patient 101 in response to a provided affect inquiry, and to receive real world activity information from the patient 101 in response to a provided real world activity. In an example, the user interface 110 can include one of a plurality of interfaces configured to provide communication between the neurological assessment tool 102 and the patient 101, a clinician or other caregiver, or one or more other users. The user interface 110 can include, but is not limited to a display, a touch screen input, a keyboard, a mouse, a camera, a microphone, a gyroscope, an accelerometer, or one or more other inputs. In certain examples, the neurological assessment tool 102 can be configured to receive information (e.g., affect information, real world information, etc.) from the patient 101 through selection, touch (e.g., draw, slide, tap, pinch, etc.), auditory, verbal, and accelerometer/gyroscope, or one or more other techniques.

In an example, the neurological assessment tool 102 can be configured to provide at least one of the affect inquiry or the real world activity to the patient 101. In other examples, one or more other devices can be configured to provide the affect inquiry or the real world activity to the patient 101, or at least one of the affect inquiry or real world activity can be delivered through a clinician or other caregiver.

The assessment module 112 can be configured to provide patient neurofunction assessment information, such as strengths and challenges in real world functions, using the received affect information and real world activity information from the patient 101. In an example, the assessment module 112 can be configured to output the patient neurofunction assessment information to the patient 101, a clinician or caregiver, or one or more other users. In an example, the assessment module 112 can be located remote from the neurological assessment tool 102, such as in a server 104 coupled to the neurological assessment tool 102 over a network 108. Patient data can be stored in the neurological assessment tool 102, the server 104, or in a database 106 remote from the server 104 and the neurological assessment tool 102.

In an example, the neurological assessment tool 102 can include a collateral assessment module 116 configured to receive collateral input from a third party 103 separate from but close to the patient 101 in response to a collateral inquiry. In an example, the neurological assessment tool 102 can be configured to provide the collateral inquiry to the third party 103. In certain examples, the third party 103 can include a plurality of separate collateral inputs, such as from a group of individuals familiar with the patient 101.

In an example, an assessment module 112 can be configured to provide patient neurofunction assessment information using affect information and real world activity information received from a patient 101, and collateral input received from one or more third party 116 separate from the patient 101. In certain examples, the computerized assessment system 100 can be configured to supplement information received from the patient with one or more collateral inquiries.

The present inventors have recognized that various affect inquiries can be provided to improve ecological validity of a cognitive assessment. In an example, the computerized assessment system 100 can be configured to provide a questionnaire to a patient followed by various affect inquires. Both the questionnaire and the affect inquiries can be configured to determine patient status with respect to various statistical mitigators, examples of which are illustrated in Table 2. However, affect inquiries focus on the current condition of a patient while undergoing assessment, whereas the questionnaire focuses on background information and statistical mitigators leading up to the assessment (e.g., the prior week, etc.). In certain examples, affect information received from the patient 101 can alter the remainder of the cognitive assessment (e.g., the real world activities, scoring of responses, etc.).

Further, the cognitive assessment can be composed of various real world activities, such as event planning, comprehension of humor, or recognition of dangerous conditions, and that the output of the assessment module 112, instead of identifying a severity or type of injury, can identify strengths and challenges in patient neurofunction with respect to real world functions, such as illustrated in FIGS. 3 and 4.

The computerized assessment system 100 can provide an output, such as a report, including, for example, a self report using information from the patient 101, a collateral report using information from the third party 103 separate from the patient 101, or performance data from the computerized assessment. Results can be compared, for example, using statistical relevance, to a healthy or known population or to a previous baseline established by the patient 101 to demonstrate whether the performance is impaired. If a previous assessment has been completed, the assessment module can compare results to one or more previous performances and statistical relevance can be determined.

Example Questionnaire

In an example, the computerized assessment system 100 can be configured to provide a questionnaire to the patient, including, for example, at least one of biographical information, medical history, sleep information, nutrition information, symptoms, daily activities, quality of life, level of experience with technology, reasons for completing the assessment, etc. The computerized assessment system can be configured to receive information from the patient in response to the provided questionnaire. In certain examples, the affect inquiries and real world activities provided to the patient can depend at least in part on the information received from the patient in response to the questionnaire. For example, if a patient is familiar with the technology, more complex real world activities can be presented to the patient for use in the assessment. In contrast, if a patient is not familiar with tablet computer inputs (e.g., multi-touch input, etc.), the real world activities presented to the patient can be tailored to the patient experience level, or the resulting assessment can be weighted accordingly.

In certain examples, the patient can invite a third party (e.g., more than one, up to three, etc.), separate from the patient, to provide collateral information about the patient. The computerized assessment system can be configured to receive information from the third party about the patient, including, for example, at least one of patient sleep information, patient nutrition information, patient symptoms, daily activity of the patient, patient quality of life, or other patient information.

Provided questions or inquiries can have different response options, such as numeric, binary, or other. Other responses, such as qualitative responses, can be stored in text form. In an example, when information is received from the patient, the assessment module can be configured to store the following information illustrated in Table 1.

TABLE 1 Own Follow- Healthy Healthy Up Collat- Baseline (if Popula- Assess- eral available) tion ment Report Degree of Change Actual Mode with Actual Actual If yes/no, a change in Response percent of Response Response response is color population coded. If two to five options, a change in one unit is color coded yellow, while a change of more than two units is color coded red. Percent change is used where numerical.

In Table 1, a baseline is a previous assessment. In certain examples, the baseline assessment is the prior assessment. In other examples, one or more other assessments have occurred between the baseline assessment and the current or next assessment. A healthy population is a composed of assessments from multiple healthy individuals. A follow-up assessment is the current assessment to be compared to the baseline assessment. If there is an existing baseline to which the current assessment can be compared then each score is compared to the selected baseline assessment and is displayed with the percent change.

A collateral report is information about the patient from a third party separate from but familiar with the patient. The degree of change signifies the amount of difference between the baseline assessment and the follow-up assessment, where the Percent Change=Baseline−Follow up/Baseline.

Standardized Performance Assessment

In certain examples, after receiving questionnaire information from the patient, the neurological assessment tool can be configured to provide standardized performance assessment activities or inquiries to the patient. Table 2, below, illustrates approximately 50 real world example activities that can be provided to the patient, using, for example, a computerized assessment system. In an example, the computerized assessment system can include a tablet or other portable or stationary computer having one or more inputs configured to receive information from the patient to assess cognition, mood, pain, anxiety, sensory skills, fine motor skills, balance, etc. In certain examples, one or more of the real world activities can be delivered as functional, game-like, everyday activities, such as identifying safety hazards in images, etc.

In an example, the computerized assessment system can include a database configured to store a large number of different real world activities. When a patient undergoes multiple assessments close in time, different real world activities can be provided (e.g., randomly) to minimize the probability of learning effecting performance, which has been a criticism of other clinical assessment tools and have affected their clinical utility, requiring six months to a year between assessments. For example, in the activity where four words need to be remembered, these 4 words are randomly chosen from a database of words (e.g., greater than 20 words, etc.). In other examples, (e.g., the fundraising activity shown in Table 2, below), the concept can remain the same, but another version can be drawn from the bank of versions where details of the tasks and rules are changed. In certain examples, each activity can be time limited, with a maximum amount of time assigned to each activity.

In an example, the computerized assessment system can be configured to provide one or more of the following activities illustrated in Table 2, including a description of each activity, how the neurological assessment tool is configured to interact with the patient, how the data is sorted, and the skill the activity is mapped to.

TABLE 2 How Data Num Activity Description Collected Data Scoring Maps to Skill  1 Fatigue How tired are Touch to Display Affect at time you feeling now? select (Statistical of assessment Not at all, a little, Mitigator) somewhat, very, extremely  2 Sleep # hours of sleep Touch to Display Affect at time last night (5 select (Statistical of assessment options: less than Mitigator) 5, 5-7, 7-8, 8-9, more than 10)  3 Mood How are you Touch to Display Affect at time feeling on the select (Statistical of assessment Mood Scale? mitigator) [in words] Visual analog scale from 0 to 10; sad to happy  4 Pain Are you Touch to Display Affect at time experiencing select (statistical of assessment pain? mitigator) [in words] Visual analog scale from 0 to 5; pain free to painful  5 Font Size Which size do Touch to Display font Sensory - you find most select size able to visual acuity comfortable to read read? (pre-requisite) Sentences presented to read aloud from larger to smaller  6 Read Read a Verbal Display result Reading Passages paragraph aloud Touch to (pre-requisite) Aloud and select administrator chooses quality of how read from four options  7 Hand Which hand do Touch to Display Background Dominance you write with? select (Background) Right, Left, Both  8 Touch 15 pictures Touch to Pre-requisite - Sensory - objects as appear at varying select must be able to neglect in they appear speeds that need (Multiple) complete or midline to be touched unable to continue Display time **  9 Color 3 plates On-screen # correct/3 Sensory - color Blindness discerning if they touch Pre-requisite - blindness can read to number pad must be able to number within w Enter complete or the plate unable to presented continue 10A Anxiety How anxious are Touch to Display Affect early in you feeling right select (Statistical the assessment now? Mitigator) Multiple choice - Extremely, Somewhat, A Little, Not at all 10B Anxiety 23 activities later - Touch to Display Affect later in (repeated) they are asked select (Statistical the assessment again about level Mitigator) of anxiety as per above 11 Headphone Can you hear the Touch to Pre-requisite - N/a check crowd cheering? select must be able to Yes/No complete or unable to continue 12A Hearing 20 sounds from Touch to Pre-requisite - Sensory - Test 15 Hz to 21000 select must be able to hearing Hz are presented hear middle and client range sounds presses ‘heard or unable to sound’ when continue they can hear Display the Hz sound of the sounds heard Determine range of sounds client able to hear Identify if there are inconsistencies in range (e.g., missed sounds within range that they were able to hear) 12B Hearing 9 sounds split Touch to #correct/9 Sensory - Test - by between left, select Determine if hearing Side right, and both any pattern - ears. Listen to e.g., can't hear sound and person on left or right presses whether and to which heard in left, range - high, right or both medium, low ears. 13A Shape cut A shape is cut Touch to #correct/2 Visual out out of a solid select perception - rectangle and spatial need to select which of 4 shapes were cut out - 2 rounds 13B Visual A solid drawing Touch to #correct/2 Visual closure is shown and select perception - need to choose closure which of the four dotted drawings match it 2 rounds 13C Match and A two-digit Touch to #found/5 X 2 Sensory - scan number is select False visual scanning numbers highlighted to (multiple) positives: # match on screen ** with same Score: numbers in #found/10 different order minus false with only five positives matches to be made 2 rounds 13D Word fit A word is Touch to #correct/2 Visual presented and select perception - need to select spatial from four options which box it fits into 2 rounds 13E Rotation A drawing is Draw Display beside Visual presented and it target response perception - needs to be Determine if rotation drawn to correct: CBA specified rotation - responds Yes ¼ or ½ turn (1 pt) or No 2 rounds (Opt) ** Display time 13F Mirror A drawing is Draw Display beside Visual Images presented that target response perception - needs to be Determine if mirror completed via correct: CBA mirror image 2 responds Yes rounds (1 pt) or No(Opt) ** Display time 13G Copy A drawing is Draw Display beside Visual complex presented that target perception - drawing needs to be response Complex copy copied Determine if correct: CBA responds: Completely accurate (2 pt) or Partially Accurate (1 pt) or Not Accurate (0 pt) ** Display time 13H Clock draw Instruction Draw Display beside Visual provided to draw target perception - face of clock response spatial, with time set to a By CBA: planning specific time Planning Points: Clock face (1) Clock numbers shown (1) Clock numbers accurate (1) Long hand for minute (1) Short hand for hour (1) Total #/5 Spatial Points: Circle face, not oval/other shape (1) Numbers in proper positions (1) Right time displayed (1) ** Display time 14 Find the Two pictures Touch, to #correct/6 Attention- Differences presented; select ** Display Selective (to picture on right (multiple) time detail) has 6 differences that need to be found 15A Items to Coach asks Type #words/4 Immediate remember person to (multiple) #trials memory - to remember four **Display time auditory items (randomized from bank of variables) and they need to type them in; they can listen up to three times 15B Items to 15 questions Type #/4 Delayed remember later; asked to (multiple) ** Display memory - recall the items time auditory and by typing in written 16 Part of Day What part of the Touch to Display target Temporal day is it? select response and awareness Morning, actual response Afternoon, Determine if Evening correct (Y/N)’ 17A Math 20 math Onscreen #correct/20 Simple to questions - questions that touch ** Display moderate no include all four number pad time problem distraction operations are w Enter solving presented and answers submitted via on screen key pad 17B Math 18 activities Onscreen #correct/20 Selective questions - later; more math touch ** Display attention with equations are number pad time distraction completed with w Enter Difference in audio distraction number correct of crowd and time cheering between no distraction and distraction 18A Press logo Plays sound and — — — when a instructs person particular to touch logo sound next time they played hear it and type in the sentence that is displayed 18B Sound plays Sound plays 12 Touch to Recalled Y/N Prospective to cue to activities later to select Type Sentence typed memory to touch logo cue person to sentence Y/N auditory cue, 2 touch logo then Display target step type the sentence sentence and they were to written recall sentence 19 Puzzle An easier and Slide Completed Constructive more complex (multiple correctly? Y/N ability puzzle are pieces) For each one_(:) displayed then #of pieces broken into 9 correctly pieces to be placed for rebuilt 2 rounds Puzzle 1 Puzzle 2 (more challenging) 20A Remember A photo of a — — this person's person is shown picture and they are to touch the picture next time that they see it in the assessment 20B Touch 13 activities Touch to Recalled? Y/N Prospective person's later, the picture select memory to picture of the person is visual cue in another activity, they need to touch it if they recognize it 21 Making Need to enter Onscreen #correct/2 Simple change how much touch ** Display problem change is number pad time for each solving expected given with Enter money given and cost of purchase 2 rounds 22A End of Test Shown the — — Gesture screen at the end of the assessment and asked to remember to vertically swipe it at the end of the assessment when shown for reward 22B End of Test 25 activities later Vertical Recalled Y/N Prospective screen need to recall to swiping memory to vertically swipe over image visual cue the picture and then music will play 23 Route A map of a town Tracing a Destination Route Finding finding on with familiar route reached? Y/N map types of leaving (round 1, round locations breadcrumbs 2) displayed; asked Efficient route to find most Y/N direct route Each round between two total of 2 locations - a Additionally simple one and a for complex harder one; then were the en asked to route route between, two destinations locations making reached? two stops along Efficient Y/N the way Total of 4 for complex 24 Candy Jar Asked to slide Sliding to ** Fine motor and pinch jar lid Left - time speed and candies into the Pinching to Right - time coordination jar as quickly as jar lid Alternating - possible (visual time highlight when Pinching - time in target zone) Practice round 5 candies with left 5 candies with right 10 candies alternating 9 between left and right 10 candies pinching (sound feedback with pinch) 25A Meet your Presented with a Touch to #/20 met Temporal team large group of select; awareness people and need Touch to to remember the close faces (20) and names (5 of 20) while party conversation plays in headphones 25B Recall your 12 activities later Slide to #correctly Delayed recall team they are shown location identified from - to faces and 30 pictures (20 (multiple previous #false names team members, options) positives 10 visitors) and Type in #names/5 asked to slide names correctly each person to remembered either Home Team (Your Team) or Visitors' Team (Other Team) and if they know their name to type it 26A Thinking of A category is Typing Display items Mental items in presented; need #items correct flexibility category to type in as to category many items as possible during time that belong the category 2 rounds 26B Thinking of 9 activities later Typing Display items Selective items in as above but with #items correct Attention category crowd cheering to category with at same time 1 Difference in # distraction round of items 27A Thinking of Up to six items Typing Correct Abstract category are presented and category? Y/N reasoning from items the category is Display items typed in as soon entered as known #entries to correct answer Time to correct response 27B Thinking of 8 activities later Typing Correct Selective category as above but with category? Y/N Attention from items crowd cheering Display items with at same time entered distraction #entries to correct answer Time to correct response Compare #entries and time to correct with no distraction 28A Sticky Note A sticky note is — — — with Appt displayed with Details four details about an appointment that need to be recalled for later (who, time, date, place) 28B Recall 7 activities later Typing Display Delayed appointment asked to recall responses memory - to details details of beside target written with appointment and response cues type them into #details/4 four provided correct spaces cued by who, date, time and place. 29A Put pictures 5 pictures of Sliding to #/5 in correct Sequencing ~ in order household task location location to pictures are presented and ** Time to need to slide complete them into order 29B Putsentences in 8 sentences are Sliding to #/8 in correct Sequencing - order displayed and location location written steps need to slide ** Time to them into the complete correct order (familiar and less familiar functional activities) 3 rounds 30 Recall Players dressed Touch to #/3, 4, or 5 Immediate player in red and blue select recalled memory - positions (5 jerseys are (multiple) Compare to visual spatial Sets) with presented on distraction to and without screen - asked to no distraction audio remember background location of players in red jerseys (randomized location) with 3, 4 and 5 players in red. Two rounds with audio playing of crowd cheering. 5 rounds 31 Touch 4 pictures of Touch to #/4 correct Social skill - Emotions people with select recognizing different emotion emotions and asked to select the picture of emotion requested 4 rounds 32 Sorting into 20 household Slide to #/20 into Abstract categories items location correct reasoning - (20 Items to (randomized (multiple category Categorizing Sort) from bank of choices) ** display time items) are presented and need to slide them to the category where they best fit: school bag, drawers, kitchen cupboards, fridge/freezer, or sports bag 33 Time since How many Onscreen Display time Temporal started Ax minutes have touch key started and Awareness (recall passed since you pad with time estimated picture here started the Enter Display also) assessment? difference Enters number of minutes 34 Bigger An illustration Touch to For each round - Abstract picture (2 (randomized select display #/key reasoning - Big rounds) from bank of (multiple) messages; picture illustrations) is display thinking shown and asked whether ‘What is going immediate or on or what has eventual happened in this picture' and person responds out load to time limit and then administrator checks off which key messages were heard and whether right away or later in response 2 rounds 35 Fundraiser In a paragraph Touch, hold #/11 tasks Executive planning there is a and slide; placed on Functioning - description of 11 Slide to agenda planning, tasks that need to move; #/XX rules organizing, be completed Touch to followed in implementing, over the course select ordering tasks reviewing/reflect- of the day to ** Display ing assist with a time out of fundraiser. They available time have rules and nuances to them that indicate that they need to be organized into a particular order for efficiency. By touching or holding and sliding them the tasks are put on the agenda for the day by time. 36 Identifying 10 pictures Touch to #/12 safety Judgment for safety (randomized select hazards safety - hazards from bank of (multiple) identified Identification pictures) are presented and need to identify all the hazardous pictures 2 rounds 37 Unsafe A picture is Touch to #/4 correct Foresight for consequences shown of a safety select Display target safety hazard and they and actual are asked what is response for the worst that each could happen and select: Death or severe injury, minor injury, Inconvenience or additional work, Nothing. 4 rounds 38 What to do Then they are Touch to #/4 correct Judgment for re: safety asked if the select Display target safety - Action worst does and actual happen, what response for needs to be done: each call emergency services, seek medical treatment on your own, call service professional or fix yourself, or Nothing 4 rounds 39 Modified Asked to ignore Touch to #/15 correct Impulsivity Stroop Test the what the select ** display time word reads but touch the color that the word is written in (which is different) 15 Rounds 40A Online Instructions on a Touch to All bills paid = Executive Banking home screen to select 1 functioning & (>18 years pay three bills Onscreen No negative, Combined old) (set date for numeric key balance = 1 Skills them) and to pad for Money transfer money amount transferred from checking to correctly = 1 savings account Score out of 3 on pay day, but ** Display no overdraft and time can't move money from savings 40B Homework Instructions Touch to All school Executive planning home screen to select tasks functioning & (<18 years study for a quiz, Slide to scheduled = 1 Combined old) complete an move No conflicts = Skills assignment and 1 study for a test # Rules on different following = up dates, with rules to 3 related to other time commitments over the course of a week. Press To-Do List button to get to list of tasks, description and their due date. Slide tasks into weekdays displayed at bottom of screen 41 Matching - Need to match as Touch to # Matches Divided don't let the many objects as select made attention pot boil over possible in the matches #pots moved/ kitchen scene Touch and # pots while watching slide to sink Score weights that the pot on each task the stove does equally not boil over and moving it to remove water from it before it does 42 Listen to a A lecture of Touch to #details/20 Immediate Lecture approximately 1 select recalled memory - to minute 15 (multiple) auditory, seconds is complex, novel listened to on a novel topic. After the person says everything that they can remember and the administrator checks off which of the 20 details they recalled. 43 Prioritizing Tasks are Slide to #/3 or 5 in Prioritizing tasks presented with move correct position differing levels ** display time of priority and need to be slid into order of priority - highest priority on top 4 rounds - 2 with 3 tasks; 2 with 5 tasks 44 Driving Hand Controls Touch for Appropriate Executive for everything. gas, brake, speed = 1 pt for functioning & Press and Hold turn. each turn Combined for the Gas and Accelerometer completed at Skills brake. Gas off, for speed. appropriate decrease speed at speed 50% rate of Avoids accelerating. obstacles = # Turn Signal is of obstacles the actuator to avoided/ make the turn number when the auto presented arrives at the Re-routed corner. Scene set safely = # so there is times/# enough distance presented between ** Time to intersections so complete that a turn is course always the “next intersection”. It is First person perspective, inside the car, Windshield frame, left hand, right hand, windshield mirrors. Mirrors are grey until a single object appears. Suburban scene, houses, trees, road, cars, pedestrians, cyclists, stop signs, left hand turn lanes. GPS is a Map navigation Window view on the current section. Audio sounds played for contact with objects. Cyclist in the right mirror remains visible during the turn, then is down on the road. Practice session at start that has them go thru 2 stop signs. Total test time 5 minutes. Driving tasks - straight, right turn, left turn, avoid obstacles/detour, busy left hand turn with obstacles; don't pay attention to distractors. Time to complete. 45 How many The number of Onscreen #/2 correct Working people on people on a train numeric memory the train? are shown before keypad with the train drops Enter over them and people move onto the train and people move off the train. Need to keep count of how many people are on the train. 2 rounds - slower, faster 46 Conversation Person listens to Touch to #/5 correct Selective at party a conversation select Display target Attention between two response and Comprehension people who actual response of humor and haven't seen ** Display inferences each other in a time to long time with complete the 5 background party questions noise and a secondary conversation nearby. They then answer 5 multiple choice questions about details or inferences from the conversation 47 Balance Tablet is Gyroscope Display Static Balance Testing positioned reading performance horizontal at hip on graph level against the Compare body difference Person is between eyes measured for 30 open and eyes seconds in the closed; left foot following and right foot positions: Standing, both feet, eyes open Standing, both feet, eyes closed Tandem, eyes open Tandem, eyes closed Left foot, eyes open Right foot, eyes closed 48 Time Time is tracked — Add up all the Information by question time of those processing where is there is selected above speed an asterisk in the and display (A) scoring section Add up pauses of the question and display (B) above; as well as Add up total time of pauses; amount of time as well as overall of assessment time (C) A + B/C 49 Administrator Administrator Touch to Display Information Notes: rates their select response processing About observation of Speed information and opinion on processing information speed processing speed: Much slower than Normal; Slightly slower than Normal; Normal 50 Administrator Administrator Touch to Display Endurance Notes: rates their select response About observation of Endurance and opinion on endurance: Much less than normal Slightly less than normal Seemed about normal 51 Administrator Administrator Touch to Display Comprehension Notes: rates their select response and About observation of Communication Comprehension and opinion on and comprehension Communica- and tion communication: Much more difficult than normal Slightly more difficult than normal Seemed about normal 52 Administrator Administrator Touch to Display Mood and Notes: rates their select response Behavior About observation of Mood and and opinion on Behavior information processing speed: Significant fluctuations in mood and behavior Slight fluctuations in mood and behavior Expected mood and behavior 53 Administrator Administrator Type Display text Additional notes - documents Notes Other additional notes about the assessment: that may affect validity, informal observations, more details on the above areas

Reporting by Area/Cognitive Skill

Each activity in Table 2 maps to a cognitive skill. The computerized assessment system can include an assessment module configured to provide neurofunction assessment information using the information received from the patient in response to each provided activity. In an example, the neurological assessment tool or one or more other display can be used to provide an assessment report. Details of the assessment report are important to different disciplines of healthcare professionals as they examine the data as related to their scope of practice, to assist with clinical diagnosis, treatment planning, or other recommendations.

The assessment module can be configured to break the measured skills into separate categories, each serving a separate purpose. For example, Table 3 illustrates patient affect inquiries at the time of assessment and associated affect measurement information, whereas Table 4 illustrates patient sensory and pre-requisite skills to perform such assessment.

TABLE 3 Affect at Time of Assessment: Area Measurement Fatigue Comparison to own baseline if available Sleep Mode of normal population; % of Anxiety - early in population assessment If two to five options: Anxiety - late in A change in one unit is color coded yellow. assessment A change of more than 2 units is color Mood coded red. Pain Additionally for anxiety, early and late are compared to each other.

TABLE 4 Sensory & Pre-Requisite Skills; Visual Hearing Reading Acuity Range Ability to Neglect Left/Right/Both read paragraph Color blindness ears aloud Visual perceptual skills - a total score is added; details are also provided by each type of visual perceptual skill: Spatial (13A + 13D + 13H spatial points) Scanning Rotation Mirror Copy Planning (13H planning points)

For each activity, assessment information, such as that displayed in Table 1, can be stored for the patient.

Many of the skills displayed in Table 2 are mapped to multiple activities. For example, the skill, “Attention-Selective-To Auditory Distraction,” is mapped to activities 17B, 26B, 27B, and 46. In certain examples, a specific activity mapped to a specific skill can better indicate patient strength or challenge associated with that skill. Accordingly, different activities can have different weights when assessing neurological function with respect to said activity, as illustrated in Table 5.

TABLE 5 Activity # included and Cognitive Skill Weighting (if applicable) Attention - Selective - To Visual 14 Distraction Attention - Selective - To Auditory 17B -10% Distraction 26B - 25% 27B - 25% 46 - 40% Attention - Divided 41 Memory - Immediate - For Auditory 15A Memory - Immediate - For Visual 30 Spatial Memory - Immediate - For Auditory, 42 Complex, Novel Memory - Delayed - For Auditory & 15B Written Memory - Delayed - For Face and 25B Names Memory - Delayed - For Written and 28B Cued Memory - Prospective - Auditory, 2 18B steps Memory - Prospective - Visual Cue 20B - 50% 22B - 50% Memory - Working 45 Temporal Awareness 16 - 20% 25A - 50% 33 - 30% Problem Solving 21 - 40% 17A 60% Constructive Ability 19 Route Finding 23 Sequencing 29A (20%) 29B (80%) Emotion Recognition 31 Mental Flexibility 26A Abstract Reasoning 27A - 30% 32 - 20% 34 - 50% Judgment for safety 36 - 40% 38 - 60% Foresight for safety 37 Impulsivity 39 Comprehension & Humor Inferences 46 Executive Functioning and 35 - 30% Combined Skills 40A or 40B (by age) - 20% 43 - 10% 44 - 40% Information Processing Speed 48- 80% 49- 20% Endurance 50 Comprehension & Communication 51 Mood and Behavior 52

TABLE 6 Activity # included and Physical Skill Weighting (if applicable) Fine Motor 24 Balance 47 - comparison in overlaying graphs

The cognitive skills can be displayed on a web graph, such as illustrated in the example of FIG. 3. Further, for each of the above, assessment information, such as that displayed in Table 1, can be stored for the patient, such as in a database 106. Further, any background information on the patient collected during the assessment, such as medical history, medications, medication dosage, demographic information, diet, exercise habits, general sleep quality, etc., can be indexed and stored in the database 106. As the database grows, it can become a valuable tool in understanding brain disorders with respect to patient performance with real world activities.

Analysis by Skill Classification

Most cognitive skills can be classified as foundational, intermediate, or complex, with a few cognitive skills that apply at all levels. In an example, an assessment module can provide patient neurofunction assessment information including providing performance on cognitive skills grouped and displayed in a chart, e.g., using a neurological assessment tool, that illustrates the strengths and challenges within each cognitive skill classification, for example, such as illustrated in FIG. 4.

For each activity score of a single patient, the current performance will have a percent change from a baseline, where a baseline is any prior test, not necessarily just the prior test. The percent change can determine a strength or a challenge compared a previous performance. The patients activity score can be compared to a healthy population score to determine whether the patient has a strength or a challenge in that activity. Activity scores are generally classified into foundational, intermediate, or complex activities. In an example, as more patient data is stored in the computer assessment system, the weighting or regression analysis can be adjusted to determine an optimum formula for assessing mild to moderate brain disorders.

Analysis for Strengths and Challenges

In an example, the assessment module can be configured to provide patient neurofunction information to, e.g., to a user, such as by using a display on the neurological assessment tool. In general, it is dependent on the professional discipline on whether the change between baseline and the current comparison would be viewed as clinically significant to warrant further assessment for diagnosis or effectiveness of intervention. Within our assessment, at times, no change in results, a reduction in results, or an improvement in results would be desired clinically. Importantly, it can be how the results present combined that is clinically significant and useful. As such, the concept of clinical significance is not used in this assessment in its traditional form. Instead, the assessment module can determine patient strengths and challenges to assist clinicians in clinical reasoning and recommendations.

However, it is important to note that it is strongly recommended that the baseline and comparison method as described above is considered by the qualified health professional first. Results from this data allow a person to be directly compared to their own previous performance and any discrepancies can be reviewed for cause/diagnosis and amendments to intervention plan. Strengths and challenges in one's own neurofunction can be identified when comparing a person's own previous healthy baseline assessment to their current assessment performance. A strength remains when they perform at or above their own previous performance and a challenge is identified when they perform below their previous performance, after consideration to reliable change.

The comparison of a functional group that is matched for age range, education level, whether English is a second language and typing ability (on applicable questions) to a person's individual performance is intended to provide guidance to a healthy range of function and to better understand when a person functions above this range (strength) or below this range (challenge) compared to others. This analysis becomes particularly significant as a starting point for a person who may not have had a healthy baseline assessment completed. The analysis is completed using z-scores to determine if the score falls in 1.96 z-scores of the population, where z=(x−mu/s), where mu is the population mean by age, education, second language, s is standard deviation. It is important to note that because we constantly add to our database, we are able to refresh the normative data as desired. In future, we will also compare a person who has had experienced a brain disorder to a like distribution.

Reliable Change (RC) is whether people have changed sufficiently that the change is unlikely to be due to simple measurement unreliability. It is determined by seeing if the difference between the comparison and baseline scores is more than a certain level. That level is a function of the initial standard deviation of the measure and its reliability.

The formula for the standard error of change is:

SD1*sqrt(2)*sqrt(1−rel),  Eq. 1

where SD1 is the initial standard deviation, sqrt indicates the square root, rel indicates the reliability, preferably determined using the Cronenbach coefficient.

The formula for criterion level, based on chance that would happen less than 5% of the time by unreliability of measurement alone, is:

1.96*SD1*sqrt(2)*sqrt(1−rel).  Eq. 2

The effect of statistical mitigators as identified in the above chart are used in data analysis. The Reliable Change from performance data is also compared to indicators of functional participation and satisfaction as obtained in the Questionnaire and Collateral-Report phases of the assessment.

In an example, consenting patients can choose to have their medical data mirrored to a Living Brain Bank, (after removing their identifying personal and health information), so that data for validation of the population can accrue without specific recruitment and be constantly available to qualified researchers for further study and validations.

FIG. 2 illustrates generally an example computerized assessment method 200 configured to assess patient neurofunction. At 202, an affect inquiry can be provided to a patient, for example, using a neurological assessment tool. Various examples of affect inquiries are illustrated above in Table 3. At 204, affect information can be received from the patient in response to the provided affect inquiry.

At 206, a real world activity can be provided to the patient, for example, using the neurological assessment tool. Various examples of real world activities are illustrated above in Table 2. In an example, the specific real world activity or order or number of real world activities provided to the patient can depend at least in part on the affect information received from the patient. At 208, real world activity information can be received from the patient in response to the provided real world activity.

At 210, patient neurofunction can be assessed using the affect information and the real world activity information received from the patient. In various examples, patient neurofunction can be provided as identified strengths and challenges in real world functions, such as illustrated in FIGS. 3 and 4.

FIGS. 3 and 4 illustrate generally example neurofunction assessment information 300, 400. In other examples, other graphs or tables can be used to provide neurofunction assessment information to the patient, clinician, caregiver, or one or more other user.

FIG. 3 illustrates generally example patient neurofunction assessment information 400, including a graph of scored real world functions for a patient. In FIG. 3, each spoke illustrates a different cognitive skill. In an example, the cognitive skills can be expressed as real world functions. The score of each real world function can start at the center of the graph and increase as it nears the perimeter, with high scores extending farther from the center. In another example, the opposite can be true, where the scores increasing in value towards the center. Changes in strengths or challenges in specific functions can be illustrated with colors, for example, green illustrating an improvement over a past assessment or with respect to one or more other baseline, population or otherwise, and red illustrating the opposite. In other examples, other indicators different than colors can be used to illustrate changes or emphasis, such as arrows, text, etc.

FIG. 4 illustrates generally example neurofunction assessment information 400 including patient strengths and challenges in different categories of real world functions, including foundational skills, intermediate skills, and complex skills. In other examples, one or more other categories can be used, such as a universal category that transcends the foundational, intermediate, and complex categories. Examples of universal skills include comprehension, communication, information processing speed, endurance, etc.

FIG. 5 illustrates generally an example computer system 500, within which a set or sequence of instructions may be executed to cause the machine to perform any one of the methodologies discussed herein, according to an example embodiment. Computer system machine 500 may be embodied by the electronic processing systems implemented by the servers 104 and database 106, the neurological assessment tool 102, or any other electronic processing or computing platform described or referred to herein.

Example computer system 500 includes at least one processor 502 (e.g., a central processing unit (CPU), a graphics processing unit (GPU) or both, processor cores, compute nodes, etc.), a main memory 504 and a static memory 506, which communicate with each other via an interconnect 508 (e.g., a link, a bus, etc.). The computer system 500 may further include a video display unit 510, an alphanumeric input device 512 (e.g., a keyboard), and a user interface (UI) navigation device 514 (e.g., a mouse). In one embodiment, the video display unit 510, input device 512 and UI navigation device 514 are incorporated into a touchscreen interface and touchscreen display. The computer system 500 may additionally include a storage device 516 (e.g., a drive unit), a signal generation device 518 (e.g., a speaker), an output controller 532, a network interface device 520 (which may include or operably communicate with one or more antennas 530, transceivers, or other wireless communications hardware), and one or more sensors 526, such as a global positioning system (GPS) sensor, compass, accelerometer, location sensor, or other sensor.

The storage device 516 includes a machine-readable medium 522 on which is stored one or more sets of data structures and instructions 524 (e.g., software) embodying or utilized by any one or more of the methodologies or functions described herein. The instructions 524 may also reside, completely or at least partially, within the main memory 504, static memory 506, and/or within the processor 502 during execution thereof by the computer system 500, with the main memory 504, static memory 506, and the processor 502 also constituting machine-readable media.

While the machine-readable medium 522 is illustrated in an example embodiment to be a single medium, the term “machine-readable medium” may include a single medium or multiple media (e.g., a centralized or distributed database, and/or associated caches and servers) that store the one or more instructions 524. The term “machine-readable medium” shall also be taken to include any tangible medium that is capable of storing, encoding or carrying instructions for execution by the machine and that cause the machine to perform any one or more of the methodologies of the present disclosure or that is capable of storing, encoding or carrying data structures utilized by or associated with such instructions. The term “machine-readable medium” shall accordingly be taken to include, but not be limited to, solid-state memories, and optical and magnetic media. Specific examples of machine-readable media include non-volatile memory, including but not limited to, by way of example, semiconductor memory devices (e.g., electrically programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM)) and flash memory devices; magnetic disks such as internal hard disks and removable disks; magneto-optical disks; and CD-ROM and DVD-ROM disks.

The instructions 524 may further be transmitted or received over a communications network 528 using a transmission medium via the network interface device 520 utilizing any one of a number of well-known transfer protocols (e.g., HTTP). Examples of communication networks include a local area network (LAN), a wide area network (WAN), the Internet, mobile telephone networks, plain old telephone (POTS) networks, and wireless data networks (e.g., Wi-Fi, 2G/3G, and 4G LTE/LTE-A or WiMAX networks). The term “transmission medium” shall be taken to include any intangible medium that is capable of storing, encoding, or carrying instructions for execution by the machine, and includes digital or analog communications signals or other intangible medium to facilitate communication of such software.

Certain embodiments are described herein as including logic or a number of modules, components or mechanisms. A module, logic, component or mechanism (herein after collectively referred to as a “module”) may be a tangible unit capable of performing certain operations and is configured or arranged in a certain manner. In example embodiments, one or more computer systems (e.g., a standalone, client or server computer system) or one or more components of a computer system (e.g., a processor or a group of processors) may be configured by software (e.g., an application or application portion) as a “module” that operates to perform certain operations as described herein.

In various embodiments, a “module” may be implemented mechanically or electronically. For example, a module may comprise dedicated circuitry or logic that is permanently configured (e.g., within a special-purpose processor) to perform certain operations. A module may also comprise programmable logic or circuitry (e.g., as encompassed within a general-purpose processor or other programmable processor) that is temporarily configured by software to perform certain operations. It will be appreciated that the decision to implement a module mechanically, in the dedicated and permanently configured circuitry, or in temporarily configured circuitry (e.g., configured by software) may be driven by cost and time considerations.

Accordingly, the term “module” should be understood to encompass a tangible entity, be that an entity that is physically constructed, permanently configured (e.g., hardwired) or temporarily configured (e.g., programmed) to operate in a certain manner and/or to perform certain operations described herein. Considering embodiments in which modules or components are temporarily configured (e.g., programmed), each of the modules or components need not be configured or instantiated at any one instance in time. For example, where the modules or components comprise a general-purpose processor configured using software, the general-purpose processor may be configured as respective different modules at different times. Software may accordingly configure the processor to constitute a particular module at one instance of time and to constitute a different module at a different instance of time.

Modules can provide information to, and receive information from, other modules. Accordingly, the described modules may be regarded as being communicatively coupled. Where multiple of such modules exist contemporaneously, communications may be achieved through signal transmission (e.g., over appropriate circuits and buses) that connect the modules. In embodiments in which multiple modules are configured or instantiated at different times, communications between such modules may be achieved, for example, through the storage and retrieval of information in memory structures to which the multiple modules have access. For example, a one module may perform an operation, and store the output of that operation in a memory device to which it is communicatively coupled. A further module may then, at a later time, access the memory device to retrieve and process the stored output. Modules may also initiate communications with input or output devices, and can operate on a resource (e.g., a collection of information).

Example Skill Performance

If a strength is identified, the skill associated with that strength can be color coded, for example, in green, if within similar healthy/selected impaired population. In contrast, if a challenge is identified, and said challenge is below the baseline, the challenge can be color coded with respect to the amount below the baseline. For example, if the challenge is between 1 and 2 standard deviations below a baseline, the challenge can be coded in a first color (e.g., yellow), and if the challenge is greater than 2 standard deviations below the baseline, the challenge can be coded in a second color (e.g., orange). Tables 8, below, illustrates an example skill performance.

TABLE 8 Attention - Selective - to Results Results Real Life Visual Distraction Febl4-12 Jan22-13 Applications The ability to pay Find the Find the Reading close attention to Differences Differences magazines/ one aspect of between two between two diagrams information when pictures: pictures: presently visually Easier: Easier: School work despite other 6/6 differences 4/6 differences visual information Time to Time to Work competing for complete: complete: attention. X seconds X seconds More Difficult: More Difficult: Paying 5/6 differences 2/6 differences bills Time to Time to complete: complete: 20 seconds 45 seconds Percent change b/w Date 1 and Date 2: 45% Decrease

ADDITIONAL NOTES AND EXAMPLES

In Example 1, a computerized assessment system includes a neurological assessment tool configured to receive affect information from a patient in response to a provided affect inquiry and to receive real world activity information from the patient in response to a provided real world activity and an assessment module configured to provide patient neurofunction assessment information using the affect information and the real world activity information.

In Example 2, the provided real world activity of Example 1 optionally depends at least in part on the affect information received from the patient in response to the provided affect inquiry.

In Example 3, the provided affect inquiry of any one or more of Examples 1-2 optionally includes a first affect inquiry, wherein the provided real world activity of any one or more of Examples 1-2 optionally includes a first real world activity, and wherein the first affect inquiry is provided to the patient prior to the first real world activity.

In Example 4, the affect inquiry of any one or more of Examples 1-3 optionally includes a second affect inquiry provided to the patient after the real world activity.

In Example 5, the first real world activity of any one or more of Examples 1-4 optionally depends at least in part on the affect information received from the patient in response to the provided first affect inquiry.

In Example 6, the assessment module of any one or more of Examples 1-5 is optionally configured to identify the strengths and challenges in patient neurofunction using the affect information and the real world activity information and the patient neurofunction assessment information of any one or more of Examples 1-5 optionally includes patient strengths and challenges in real world function.

In Example 7, the strengths and challenges in real world function of any one or more of Examples 1-6 optionally includes at least one of: judgment for safety; foresight for safety; comprehension of humor; comprehension of inference; or event planning.

In Example 8, any one or more of Examples 1-7 optionally includes a collateral assessment module configured to receive collateral input from a third party separate from the patient in response to a collateral inquiry, wherein the assessment module of any one or more of Examples 1-7 is optionally configured to provide patient neurofunction assessment information using the affect information, the real world activity information, and the collateral input.

In Example 9, the neurological assessment tool of any one or more of Examples 1-8 optionally includes a web-enabled, portable, touch-screen tablet computer, and wherein the neurological assessment tool is configured to receive affect information and real world activity information from the patient using an input of the web-enabled, portable, touch-screen tablet computer.

In Example 10, the assessment module of any one or more of Examples 1-9 is optionally configured to receive and store affect information and real world activity information received from a plurality of patients, and to optionally provide the patient neurofunction assessment information using the affect information and the real world activity information received from the patient with respect to corresponding affect information and real world activity information received from the plurality of patients.

In Example 11, the affect information from the patient in any one or more of Examples 1-10 optionally includes at least one of: patient fatigue information; patient sleep information; patient anxiety information; patient mood information; or patient pain information.

In Example 12, a computerized assessment method includes receiving affect information from a patient, using a neurological assessment tool, in response to a provided affect inquiry, receiving real world activity information from the patient, using the neurological assessment tool, in response to a provided real world activity, and assessing, using an assessment module, patient neurofunction using the affect information and the real world activity information.

In Example 13, the method of Example 12 optionally includes providing an affect inquiry to the patient and providing a real world activity to the patient that depends at least in part on the received affect information in response to the provided affect inquiry.

In Example 14, any one or more of Examples 1-13 optionally include providing a first affect inquiry to the patient and providing a first real world activity to the patient, wherein the providing the first affect inquiry includes providing the first affect inquiry to the patient prior to providing the first real world activity to the patient.

In Example 15, any one or more of Examples 1-14 optionally include providing a second affect inquiry to the patient after providing the first real world activity to the patient.

In Example 16, the first real world activity of any one or more of Examples 1-15 optionally depends at least in part on affect information received from the patient in response to the provided first affect inquiry.

In Example 17, the assessing patient neurofunction of any one or more of Examples 1-16 optionally includes identifying patient strengths and challenges in real world function using the affect information and the real world activity information.

In Example 18, the strengths and challenges in real world function of any one or more of Examples 1-17 optionally includes at least one of: judgment for safety; foresight for safety; comprehension of humor; comprehension of inference; or event planning.

In Example 19, any one or more of Examples 1-18 optionally includes receiving collateral input from a third party separate from the patient, using a collateral assessment module, in response to a provided collateral inquiry, wherein the assessing patient neurofunction of any one or more of Examples 1-18 optionally includes using the affect information, the real world activity information, and the collateral input.

In Example 20, the receiving affect information and real world activity information from the patient in any one or more of Examples 1-19 optionally includes using an input of a web-enabled, portable, touch-screen tablet computer.

In Example 21, any one or more of Examples 1-20 optionally includes receiving and storing, using the assessment module, affect information and real world activity information from a plurality of patients, wherein the assessing patient neurofunction of any one or more of Examples 1-20 optionally includes using the affect information and the real world activity information received from the patient with respect to corresponding affect information and real world activity information received from the plurality of patients.

In Example 22, the receiving affect information from the patient of any one or more of Examples 1-21 optionally includes receiving at least one of: patient fatigue information; patient sleep information; patient anxiety information; patient mood information; or patient pain information.

In Example 23, a system or apparatus can include, or can optionally be combined with any portion or combination of any portions of any one or more of Examples 1-22 to include, means for performing any one or more of the functions of Examples 1-20, or a non-transitory machine-readable storage medium having instructions stored thereon that, when executed by a machine, cause the machine to perform any one or more of the methods or functions of Examples 1-22.

These non-limiting examples can be combined in any permutation or combination.

The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention can be practiced. These embodiments are also referred to herein as “examples.” Such examples can include elements in addition to those shown or described. However, the present inventors also contemplate examples in which only those elements shown or described are provided. Moreover, the present inventors also contemplate examples using any combination or permutation of those elements shown or described (or one or more aspects thereof), either with respect to a particular example (or one or more aspects thereof), or with respect to other examples (or one or more aspects thereof) shown or described herein.

All publications, patents, and patent documents referred to in this document are incorporated by reference herein in their entirety, as though individually incorporated by reference. In the event of inconsistent usages between this document and those documents so incorporated by reference, the usage in the incorporated reference(s) should be considered supplementary to that of this document; for irreconcilable inconsistencies, the usage in this document controls.

In this document, the terms “a” or “an” are used, as is common in patent documents, to include one or more than one, independent of any other instances or usages of “at least one” or “one or more.” In this document, the term “or” is used to refer to a nonexclusive or, such that “A or B” includes “A but not B,” “B but not A,” and “A and B,” unless otherwise indicated. In this document, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” Also, in the following claims, the terms “including” and “comprising” are open-ended, that is, a system, device, article, or process that includes elements in addition to those listed after such a term in a claim are still deemed to fall within the scope of that claim. Moreover, in the following claims, the terms “first,” “second,” and “third,” etc. are used merely as labels, and are not intended to impose numerical requirements on their objects.

Method examples described herein can be machine or computer-implemented at least in part. Some examples can include a computer-readable medium or machine-readable medium encoded with instructions operable to configure an electronic device to perform methods as described in the above examples. An implementation of such methods can include code, such as microcode, assembly language code, a higher-level language code, or the like. Such code can include computer readable instructions for performing various methods. The code may form portions of computer program products. Further, in an example, the code can be tangibly stored on one or more volatile, non-transitory, or non-volatile tangible computer-readable media, such as during execution or at other times. Examples of these tangible computer-readable media can include, but are not limited to, hard disks, removable magnetic disks, removable optical disks (e.g., compact disks and digital video disks), magnetic cassettes, memory cards or sticks, random access memories (RAMs), read only memories (ROMs), and the like.

The above description is intended to be illustrative, and not restrictive. For example, the above-described examples (or one or more aspects thereof) may be used in combination with each other. Other embodiments can be used, such as by one of ordinary skill in the art upon reviewing the above description. The Abstract is provided to comply with 37 C.F.R. §1.72(b), to allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be interpreted as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may lie in less than all features of a particular disclosed embodiment. Thus, the following claims are hereby incorporated into the Detailed Description, with each claim standing on its own as a separate embodiment, and it is contemplated that such embodiments can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled. 

What is claimed is:
 1. A computerized assessment system, comprising: a neurological assessment tool configured to receive affect information from a patient in response to a provided affect inquiry and to receive real world activity information from the patient in response to a provided real world activity; and an assessment module configured to provide patient neurofunction assessment information using the affect information and the real world activity information.
 2. The computerized assessment system of claim 1, wherein the provided real world activity depends at least in part on the affect information received from the patient in response to the provided affect inquiry.
 3. The computerized assessment system of claim 1, wherein the provided affect inquiry includes a first affect inquiry, wherein the provided real world activity includes a first real world activity, and wherein the first affect inquiry is provided to the patient prior to the first real world activity.
 4. The computerized assessment system of claim 3, wherein the affect inquiry includes a second affect inquiry provided to the patient after the real world activity.
 5. The computerized assessment system of claim 3, wherein the first real world activity depends at least in part on the affect information received from the patient in response to the provided first affect inquiry.
 6. The computerized assessment system of claim 1, wherein the assessment module is configured to identify the strengths and challenges in patient neurofunction using the affect information and the real world activity information, and wherein the patient neurofunction assessment information includes patient strengths and challenges in real world function.
 7. The computerized assessment system of claim 6, wherein the strengths and challenges in real world function includes at least one of: judgment for safety; foresight for safety; comprehension of humor; comprehension of inference; or event planning.
 8. The computerized assessment system of claim 1, including: a collateral assessment module configured to receive collateral input from a third party separate from the patient in response to a collateral inquiry, wherein the assessment module is configured to provide patient neurofunction assessment information using the affect information, the real world activity information, and the collateral input.
 9. The computerized assessment system of claim 1, wherein the neurological assessment tool includes a web-enabled, portable, touch-screen tablet computer, and wherein the neurological assessment tool is configured to receive affect information and real world activity information from the patient using an input of the web-enabled, portable, touch-screen tablet computer.
 10. The computerized assessment system of claim 1, wherein the assessment module is configured to receive and store affect information and real world activity information received from a plurality of patients, and to provide the patient neurofunction assessment information using the affect information and the real world activity information received from the patient with respect to corresponding affect information and real world activity information received from the plurality of patients.
 11. The computerized assessment system of claim 1, wherein the affect information from the patient includes at least one of: patient fatigue information at the time of assessment; patient sleep information the night prior to assessment; patient anxiety information at the time of assessment; patient mood information at the time of assessment; or patient pain information at the time of assessment.
 12. A computerized assessment method, comprising: receiving affect information from a patient, using a neurological assessment tool, in response to a provided affect inquiry; receiving real world activity information from the patient, using the neurological assessment tool, in response to a provided real world activity; and assessing, using an assessment module, patient neurofunction using the affect information and the real world activity information.
 13. The computerized assessment method of claim 12, including: providing an affect inquiry to the patient; and providing a real world activity to the patient that depends at least in part on the received affect information in response to the provided affect inquiry.
 14. The computerized assessment method of claim 12, including: providing a first affect inquiry to the patient; and providing a first real world activity to the patient, wherein the providing the first affect inquiry includes providing the first affect inquiry to the patient prior to providing the first real world activity to the patient.
 15. The computerized assessment method of claim 14, including: providing a second affect inquiry to the patient after providing the first real world activity to the patient.
 16. The computerized assessment method of claim 14, wherein the first real world activity depends at least in part on affect information received from the patient in response to the provided first affect inquiry.
 17. The computerized assessment method of claim 12, wherein the assessing patient neurofunction includes identifying patient strengths and challenges in real world function using the affect information and the real world activity information.
 18. The computerized assessment method of claim 17, wherein the strengths and challenges in real world function includes at least one of: judgment for safety; foresight for safety; comprehension of humor; comprehension of inference; or event planning.
 19. The computerized assessment method of claim 12, including: receiving collateral input from a third party separate from the patient, using a collateral assessment module, in response to a provided collateral inquiry, wherein the assessing patient neurofunction includes using the affect information, the real world activity information, and the collateral input.
 20. The computerized assessment method of claim 12, wherein the receiving affect information and real world activity information from the patient includes using an input of a web-enabled, portable, touch-screen tablet computer.
 21. The computerized assessment system of method 12, including: receiving and storing, using the assessment module, affect information and real world activity information from a plurality of patients, wherein the assessing patient neurofunction includes using the affect information and the real world activity information received from the patient with respect to corresponding affect information and real world activity information received from the plurality of patients.
 22. The computerized assessment method of claim 12, wherein the receiving affect information from the patient includes receiving at least one of: patient fatigue information at the time of assessment; patient sleep information the night prior to assessment; patient anxiety information at the time of assessment; patient mood information at the time of assessment; or patient pain information at the time of assessment.
 23. A non-transitory machine-readable storage medium having instructions stored thereon that, when executed by a machine, cause the machine to perform operations comprising: receiving affect information from a patient in response to a provided affect inquiry; receiving real world activity information from the patient in response to a provided real world activity; and assessing patient neurofunction using the affect information and the real world activity information.
 24. The non-transitory machine-readable storage medium of claim 23, wherein the operations further comprise: providing an affect inquiry to the patient; and providing a real world activity to the patient that depends at least in part on the received affect information in response to the provided affect inquiry.
 25. The non-transitory machine-readable storage medium of claim 23, wherein the operations further comprise: providing a first affect inquiry to the patient; and providing a first world activity to the patient, wherein the providing the first affect inquiry includes providing the first affect inquiry to the patient prior to providing the first real world activity to the patient.
 26. The non-transitory machine-readable storage medium of claim 25, wherein the operations further comprise: providing a second affect inquiry to the patient after providing the first real world activity to the patient.
 27. The non-transitory machine-readable storage medium of claim 25, wherein the first real world activity depends at least in part on affect information received from the patient in response to the provided first affect inquiry.
 28. The non-transitory machine-readable storage medium of claim 23, wherein the assessing patient neurofunction includes identifying patient strengths and challenges in real world function using the affect information and the real world activity information.
 29. The non-transitory machine-readable storage medium of claim 28, wherein the strengths and challenges in real world function includes at least one of: judgment for safety; foresight for safety; comprehension of humor; comprehension of inference; or event planning.
 30. The non-transitory machine-readable storage medium of claim 23, wherein the operations further comprise: receiving collateral input from a third party separate from the patient, using a collateral assessment module, in response to a provided collateral inquiry, wherein the assessing patient neurofunction includes using the affect information, the real world activity information, and the collateral input.
 31. The non-transitory machine-readable storage medium of claim 23, wherein the receiving affect information and real world activity information from the patient includes using an input of a web-enabled, portable, touch-screen tablet computer.
 32. The non-transitory machine-readable storage medium of claim 23, wherein the operations further comprise: receiving and storing, using the assessment module, affect information and real world activity information from a plurality of patients, wherein the assessing patient neurofunction includes using the affect information and the real world activity information received from the patient with respect to corresponding affect information and real world activity information received from the plurality of patients.
 33. The non-transitory machine-readable storage medium of claim 23, wherein the receiving affect information from the patient includes receiving at least one of: patient fatigue information at the time of assessment; patient sleep information the night prior to assessment; patient anxiety information at the time of assessment; patient mood information at the time of assessment; or patient pain information at the time of assessment. 